Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Int J Cancer. 2014 Jun 15;134(12):2951-60. doi: 10.1002/ijc.28624. Epub 2013 Dec 2.
Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.
尽管在国家内部和国家之间都已经证明了癌症存活率存在社会经济不平等现象，但过去诊断后不平等现象随时间变化的证据却很少。此外，在德国，尚未对癌症存活率的社会经济差异进行综合分析。因此，我们分析了德国十个基于人群的癌症登记处（覆盖 3200 万居民）在 1997-2006 年诊断出的 25 个最常见癌症部位之一的患者的癌症存活率变化情况。根据诊断时的居住地区，患者被分配了社会经济地位。期间分析用于得出每个德国贫困五分位数在 2002-2006 年的三个月、五年和有条件的一年和五年年龄标准化相对存活率。通过基于模型的期间分析，将生活在最贫困地区的患者的相对存活率与生活在所有其他地区的患者的存活率进行了比较。在 25 个癌症部位中的 21 个部位，最贫困地区的五年相对存活率低于所有其他地区的总和。25 个癌症部位的中位相对超额死亡风险从最初的 3 个月的 1.24 降至接下来的 9 个月的 1.16，再降至接下来的 4 年的 1.08。调整后的阶段后，不平等现象仍然存在。这些主要的区域社会经济不平等现象表明，德国在改善癌症护理和存活率方面具有潜力。应开展基于个体水平患者数据的研究，并获得治疗信息，以更详细地研究癌症存活率方面存在这些社会经济不平等现象的原因。
